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Differential Diagnosis: Hypernatremia

Todd Archer, DVM, MS, DACVIM, Mississippi State University

Internal Medicine

|July/August 2021|Peer Reviewed

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Differential Diagnosis: Hypernatremia

Following are differential diagnoses for animals presented with hypernatremia.

Hypotonic fluid losses (hypovolemia)

  • Extrarenal fluid losses
    • Cutaneous losses
    • GI losses (vomiting, diarrhea)
    • Third space losses
  • Renal fluid losses
    • Drug use (eg, furosemide, corticosteroids)
    • Osmotic diuresis
    • Renal disease

Pure water losses (normovolemia)

  • Diabetes insipidus (central or nephrogenic)
  • Inadequate water intake
    • Defect in thirst mechanism
    • Inadequate access
    • Neurologic disease
  • Increased insensible fluid losses (panting, fever, elevated environmental temperature)

Sodium gain (hypervolemia)

  • Hyperaldosteronism
  • Iatrogenic causes via IV fluids (hypertonic saline administration, sodium bicarbonate)
  • Increased sodium ingestion (play dough, paint ball toxicity, salt water)

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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